What Health Insurance Does Cover, and Doesn't

As required by last year’s health reform legislation, the Labor Department has put together a report on employer-sponsored health insurance coverage that shows what benefits are typically covered by these plans. The results, in one chart:

Source: Labor Department, “Selected Medical Benefits: A Report from the Department of Labor to the Department of Health and Human Services”

A service is counted as “covered” whether or not 100 percent of the service is paid for by the insurance plan. The report listed a service as “covered” if the health plan documents specifically mentioned coverage of it (as opposed to not mentioning it, or specifically saying that the service was excluded).

As you can see, having private insurance doesn’t guarantee that the life-saving service you need — like kidney dialysis, or an organ transplant — will be covered at all by your plan. And even some services that would be considered relatively basic by many patients, like regular gynecological exams, are excluded.

It’s important to keep this in mind in discussions about giving more Americans access to “health insurance.”

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